Older persons and malaria treatment in Nigeria

This study examined the prevalence and pattern of health-seeking behavior of older people on malaria fever among the elderly in Nigeria.  Data from the Nigeria Malaria Indicator Survey were used with a weighted sample of 1819 older persons aged 60 and above across the six geopolitical regions in Nigeria. The odds of fever as well as treatment seeking were predicted using logistic regression models. The prevalence rate of fever among the aged in Nigeria is 28%. About half of the respondents did not receive treatment in a standard health facility. There is high patronage of chemist/patient medicine vendor/shops for malaria fever treatment among older people in Nigeria. Findings suggest that older people may use healthcare facility if it is affordable. The lifelong approach that can reduce poverty and illiteracy is recommended since the rural-urban differences in treatment seeking reduced with the inclusion of other socio-demographic variables in the model

Health Seeking Behaviour of Tiv Women Living with Fibroid in Benue State, Nigeria

Uterine fibroids are the most common benign tumors and one of the foremost causes of infertility among women. While there are several clinic-based studies on the biological context of fibroid, very few had examined its socio-cultural context in a community study in Nigeria. This paper, therefore, examined health seeking behaviour of women living with fibroid in Tiv communities in Benue State, Nigeria. The study participants were selected from 4 Tiv speaking local government areas (Gboko, Makurdi, Ukum and Vandeikya) in Benue State through multi stage sampling technique. Sequential explanatory mixed method of data collection was used. Fibroid occurrence is common among women in age categories 30-39 (51%). All the respondents living fibroid sought treatment, however, 60% of the respondents prefer orthodox medical treatment while the remaining 40% prefer the traditional healing process. Income, proximity to healthcare facility, influence of relatives, friends, and health professionals have stronger influence on the health seeking behaviour of women living with fibroid. The health seeking is combination of both traditional and modern medicines while surgical procedure is less utilised. The study recommends an increased sensitization and awareness about fibroid

A contextual exploration of healthcare service use in urban slums in Nigeria

Introduction Many urban residents in low- and middle-income countries live in unfavorable conditions with few healthcare facilities, calling to question the long-held view of urban advantage in health, healthcare access and utilization. We explore the patterns of healthcare utilization in these deprived neighborhoods by studying three such settlements in Nigeria. Methods The study was conducted in three slums in Southwestern Nigeria, categorized as migrant, indigenous or cosmopolitan, based on their characteristics. Using observational data of those who needed healthcare and used in-patient or out-patient services in the 12 months preceding the survey, frequencies, percentages and odds-ratios were used to show the study participants’ environmental and population characteristics, relative to their patterns of healthcare use. Results A total of 1,634 residents from the three slums participated, distributed as 763 (migrant), 459 (indigenous) and 412 (cosmopolitan). Residents from the migrant (OR = 0.70, 95%CI: 0.51 to 0.97) and indigenous (OR = 0.65, 95%CI: 0.45 to 0.93) slums were less likely to have used formal healthcare facilities than those from the cosmopolitan slum. Slum residents were more likely to use formal healthcare facilities for maternal and perinatal conditions, and generalized pains, than for communicable (OR = 0.50, 95%CI: 0.34 to 0.72) and non-communicable diseases (OR = 0.61, 95%CI: 0.41 to 0.91). The unemployed had higher odds (OR = 1.45, 95%CI: 1.08 to 1.93) of using formal healthcare facilities than those currently employed. Conclusion The cosmopolitan slum, situated in a major financial center and national economic hub, had a higher proportion of formal healthcare facility usage than the migrant and indigenous slums where about half of families were classified as poor. The urban advantage premise and Anderson behavioral model remain a practical explanatory framework, although they may not explain healthcare use in all possible slum types in Africa. A context-within-context approach is important for addressing healthcare utilization challenges in slums in sub-Saharan Africa

Development of a video-observation method for examining doctors’ clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria

Background: Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients’ department in Nigeria. We also develop measurement procedures and examine measurement characteristics. Methods Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. Results: We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was ‘above standard’ (or 4 on a scale of 1–5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen’s kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. Conclusions: Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan : results of pre-COVID and COVID-19 lockdown stakeholder engagements

Abstract Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. Conclusion Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered

Pharmacies in informal settlements : a retrospective, cross-sectional household and health facility survey in four countries

Background Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a “pharmacy” across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor

Analysis of OpenStreetMap data quality at different stages of a participatory mapping process : evidence from slums in Africa and Asia

This paper examines OpenStreetMap data quality at different stages of a participatory mapping process in seven slums in Africa and Asia. Data were drawn from an OpenStreetMap-based participatory mapping process developed as part of a research project focusing on understanding inequalities in healthcare access of slum residents in the Global South. Descriptive statistics and qualitative analysis were employed to examine the following research question: What is the spatial data quality of collaborative remote mapping achieved by volunteer mappers in morphologically complex urban areas? Findings show that the completeness achieved by remote mapping largely depends on the morphology and characteristics of slums such as building density and rooftop architecture, varying from 84 in the best case, to zero in the most difficult site. The major scientific contribution of this study is to provide evidence on the spatial data quality of remotely mapped data through volunteer mapping efforts in morphologically complex urban areas such as slums; the results could provide insights into how much fieldwork would be needed in what level of complexity and to what extent the involvement of local volunteers in these efforts is required

Ethnic, Religious and Educational Homogamy in Nigeria

The study examines the extent to which Nigerians marry within circumscribed social groups, or choose marital partners who are similar to them in status, a phenomenon termed homogamy. Ethnicity, religious affiliation and educational attainment are three important variables in mate selection in Nigeria. To what extent is Nigerian marriage ethnically, religiously and educationally homogenous? This question is addressed with the use of couples’ data derived from the 2003, 2008 and 2013 Nigeria Demographic and Health Survey (NDHS), from which information on marital union and patterns was analyzed. The large sample size of the NDHS data, their periodicity and national representativeness justify their appropriateness for this study. The analysis involved computation of gross measure of homogamy by ethnicity, education and religion; also the odds of homogamy were examined based on selected characteristics of husbands and wives using logistic regression. The results indicate a very high level of homogamy; about 9 of 10 couples in Nigeria are married within their ethnic and religious groups. The level of educational homogamy is much lower (about 60 percent). Factors that give rise to the different patterns evident in the study are discussed and suggestions proferred for a more exogamous spousal selection in the country

Interaction effects of maternal education and household environment on child mortality in Nigeria

Various intervention programmes targeted at different preventable childhood infections that can lead to child mortality have been implemented in Nigeria. While these global initiatives and programmes may have contributed to decline in childhood mortality rates over the years, the rate is still high in Nigeria. The causes of death are specific to different age categories; child mortality (ages 12 to 59 months) has been linked in several studies in Nigeria to household environment and maternal characteristics, among others. However, there is a dearth of information on the interaction effect of maternal education and household characteristics on child mortality in Nigeria. The key question is does maternal education affect the handling of household environment and related practices to the extent of being a significant predictor of child mortality? This paper therefore examined the interaction of maternal education and household environment on child mortality in Nigeria. Using Mosley and Chen’s analytical framework, 45,603 children (12-59 months) were selected from NDHS 2013 dataset. Interaction of maternal education and household environment is significant (p<0.05) predictor of child mortality in Nigeria. Children aged 12 to 59 months that live in a disadvantaged household environment and whose mothers do not have formal education have a higher risk of child mortality than those with formal education. This study confirms the significance of maternal education to child survival in Nigeria